Contents

Abstract

Background: To improve access to skilled attendance at delivery and
thereby reduce maternal mortality, the Government of Ghana introduced a
policy exempting all women attending health facilities from paying
delivery care fees.

Objective: To examine the effect of the exemption policy on
delivery-related maternal mortality. Methods: Maternal deaths in 9 and
12 hospitals in the Central Region (CR) and the Volta Region (VR)
respectively were analysed. The study covered a period of 11 and 12
months before and after the introduction of the policy between 2004 and
2006. Maternal deaths were identified by screening registers and
clinical notes of all deaths in women aged 15-49 years in all units of
the hospitals. These deaths were further screened for those related to
delivery. The total births in the study period were also obtained in
order to calculate maternal mortality ratios (MMR).

Results: A total of 1220 (78.8%) clinical notes of 1549 registered
female deaths were retrieved. A total of 334 (21.6%) maternal deaths
were identified. The delivery-related MMR decreased from 445 to 381 per
100,000 total births in the CR and from 648 to 391 per 100,000 total
births in the VR following the implementation of the policy. The changes
in the 2 regions were not statistically significant (p=0.458) and
(p=0.052) respectively. No significant changes in mean age of
delivery-related deaths, duration of admission and causes of deaths
before and after the policy in both regions.

Conclusion: The delivery-related institutional maternal mortality did
not appear to have been significantly affected after about one year of
implementation of the policy.